The 2007-09 recession had a dramatic effect on behavioral health spending, with the effect most prominent for private, state, and local payers. During the recession behavioral health spending increased at a 4.6 percent average annual rate, down from 6.1 percent in 2004-07. Average annual growth in private behavioral health spending during the recession slowed to 2.7 percent from 7.2 percent in 2004-07. State and local behavioral health spending showed negative average annual growth, -1.2 percent, during the recession, compared with 3.7 percent increases in 2004-07. In contrast, federal behavioral health spending growth accelerated to 11.1 percent during the recession, up from 7.2 percent in 2004-07. These behavioral health spending trends were driven largely by increased federal spending in Medicaid, declining private insurance enrollment, and severe state budget constraints. An increased federal Medicaid match reduced the state share of Medicaid spending, which prevented more drastic cuts in state-funded behavioral health programs during the recession. Federal Medicaid served as a critical safety net for people with behavioral health treatment needs during the recession.
[Show abstract][Hide abstract] ABSTRACT: The 2007 global economic recession was the most severe recession since the Great Depression of the 1930s in terms of declines in unemployment, labor force participation and gross domestic product in the United States. In order to guide future public health policies during economic downturns, we reviewed and synthesized the literature on the health consequences of the current and prior recessions focusing on the government response to the recession in the United States. We searched for primary literature in three academic and three policy databases using the indexed and free-text terms "recession", "health", "mortality", "employment", "unemployment", "foreclosure", "pensions", fiscal", "deficit", "morbidity", "avoidable mortality", "amenable mortality", "budget", and "budget crisis" in various combinations. The search resulted in 172 English language studies published from 1 January 1980 through 1 April 2013 that met the inclusion criteria. The data synthesis was structured into two themes: new developments in our understanding of changes in morbidity or mortality risk related to recession or fiscal austerity, and public health system responses to the recession under fiscal constraints. We found consistent evidence that recessions, and unemployment in particular, can be significantly damaging to mental health, increasing the risk of substance abuse and suicide particularly for young men. We also found that the previously reported mortality declines during recessions may occur in only a few causes of death such as reduced automobile deaths. In addition, the expansion of Medicaid, Supplemental Nutrition Assistance Program, and unemployment benefits under American Recovery and Reinvestment Act of 2009 likely had substantial buffering effects on health, especially among poor women and their children. These programs often excluded young single men, who are at highest risk of substance abuse and suicide. Thus, these populations should be targeted during downturns or integrated into safety net programs before the next recession.
[Show abstract][Hide abstract] ABSTRACT: Objective:
Outpatient follow-up after hospitalization for mental health reasons is an important indicator of quality of health systems. Differences among racial-ethnic minority groups in the quality of service use during this period are understudied. This study assessed the quality of outpatient treatment episodes following inpatient psychiatric treatment among blacks, whites, and Latinos in the United States.
The Medical Expenditure Panel Survey (2004-2010) was used to identify adults with any inpatient psychiatric treatment (N=339). Logistic regression models were used to estimate predictors of any outpatient follow-up or the beginning of adequate outpatient follow-up within seven or 30 days following discharge. Predicted disparities were calculated after adjustment for clinical need variables but not for socioeconomic characteristics, consistent with the Institute of Medicine definition of health care disparities as differences that are unrelated to clinical appropriateness, need, or patient preference.
Rates of follow-up were generally low, particularly rates of adequate treatment (<26%). Outpatient treatment prior to inpatient care was a strong predictor of all measures of follow-up. After adjustment for need and socioeconomic status, the analyses showed that blacks were less likely than whites to receive any treatment or begin adequate follow-up within 30 days of discharge.
Poor integration of follow-up treatment in the continuum of psychiatric care leaves many individuals, particularly blacks, with poor-quality treatment. Culturally appropriate interventions that link individuals in inpatient settings to outpatient follow-up are needed to reduce racial-ethnic disparities in outpatient mental health treatment following acute treatment.
[Show abstract][Hide abstract] ABSTRACT: This study examines the changes in health care utilization for mental health disorders among patients who were diagnosed with depressive and/or anxiety disorders during the Great Recession 2007-2009 in the USA. Negative binomial regressions are used to estimate the association of the economic recession and mental health care use for females and males separately. Results show that prescription drug utilization (e.g., antidepressants, psychotropic medications) increased significantly during the economic recession 2007-2009 for both females and males. Physician visits for mental health disorders decreased during the same period. Results show that racial disparities in mental health care might have increased, while ethnic disparities persisted during the Great Recession. Future research should separately examine mental health care utilization by gender and race/ethnicity.
The Journal of Behavioral Health Services & Research 04/2014; DOI:10.1007/s11414-014-9403-1 · 1.37 Impact Factor
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